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Answer to your Health Question

Question (03/21/2011):

Vitamin B12 deficiency and elevated bilirubin

I am a 23 year old female and just found out that I have a vitamin B12 deficiency and elevated bilirubin and don't know what could have caused this and what I can do to correct it.


Classic vitamin B12 deficiency is characterized by macro-ovalocytosis (mean cell volume >100 fL) in a peripheral smear with hypersegmented polymorphonuclear leukocytes (at least one neutrophil with six or more lobes or 5% neutrophils with five lobes).

Other features include leukopenia and thrombocytopenia; increased lactic dehydrogenase and bilirubin levels suggest ineffective erythropoiesis.

Bone marrow examination may show megaloblastic changes.

Vitamin B12 deficiency may potentiate mental illness and further damage neurons and myelin sheaths.

Pernicious anaemia accounts for 80% of cases of megaloblastic anaemia due to impaired absorption of vitamin B12

There may be an increase in plasma unconjugated bilirubin due to increased destruction of red-cell precursors in the marrow.

Liver and thyroid function tests and protein electrophoresis may help in the differential diagnosis of macrocytosis.

B12 deficiency can be caused by insufficient stomach acid - necessary to separate B12 from ingested protein.

This is the most common cause of B12 deficiency in the elderly and individuals on drugs that suppress gastric acid production.

Deficiency may also be due to a lack of intrinsic factor, a substance produced by parietal cells in the stomach that binds with B12 before absorption by the intestines.

An autoimmune condition called pernicious anemia involves damage to the parietal cells, resulting in decreased production of intrinsic factor.

There is for pernicious anemia, although repletion of vitamin B12 should be expected to result in a cessation of anemia-related symptoms, a halt in neurological deterioration, and (in cases where neurological problems not advanced) neurological recovery and a complete and permanent remission of all symptoms, so long as B12 is supplemented.

Vitamin B12 deficiency anemia is treated with supplements of vitamin B12.

When the level of vitamin B12 has returned to normal, your body will produce more red blood cells and the symptoms will go away.

However, most people need to take supplements for the rest of their lives to prevent the condition from returning.

This is because the usual cause of vitamin B12 deficiency is poor absorption of the vitamin through the intestine.

If you stop taking the supplements, your B12 level will fall again.

Treatment of vitamin B12 deficiency or pernicious anemia consists of high doses of vitamin B12 supplements. If you have have the deficiency but no symptoms, the vitamin may be taken by mouth. Blood tests are done periodically to make sure the vitamin B12 level returns to and remains normal.

People who have symptoms due to nerve damage are usually given vitamin B12 by injection into a muscle.

Injections, which may be self-administered, are given daily or weekly for several weeks until the vitamin B12 level returns to normal.

Then injections are given once a month indefinitely, unless the disorder causing it can be corrected. Anemia usually resolves in about 6 weeks. But severe symptoms due to nerve damage-for example, dementia in older people-may not resolve.

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